Pericystic brain transcriptomics reveals molecular signatures of immune activation and neurovascular remodelling in viable and post-treatment porcine neurocysticercosis
Neurocysticercosis (NCC), the infection of the central nervous system by Taenia solium larvae, is a leading cause of acquired epilepsy in endemic regions. While viable cysticerci can persist asymptomatically for extended periods, their spontaneous or drug-induced degradation triggers marked perilesional inflammation and severe neurological symptoms. Despite well-documented histopathological characterisation of these lesion states, the host transcriptional programmes associated with viable parasite persistence and early post-treatment lesion disruption remain poorly understood. To address this gap, we performed the first bulk RNA sequencing of pericystic brain tissue using a physiologically relevant porcine model of NCC. Comparing uninfected controls (n = 3), infected untreated pigs with intact viable cysts (n = 6), and antiparasitic-treated pigs with disrupted cysts (n = 3), we identified distinct transcriptional signatures associated with each disease state. Viable infection was associated with broad transcriptional changes (461 upregulated and 175 downregulated genes), characterised by local immune activation alongside suppression of blood-brain barrier (BBB) remodelling, vascular, and neuronal signalling molecular signatures. The post-treatment state with confirmed BBB disruption was associated with a smaller but directionally distinct response (160 upregulated and 57 downregulated genes), marked by inflammatory signalling and increased expression of genes associated with endothelial activation, vascular regulation, and BBB-associated remodelling. Together, these findings suggest that, while immune engagement is a feature shared across both lesion states, the BBB-associated transcriptional axis shifts substantially following treatment. These results provide an exploratory transcriptomic framework for understanding parasite persistence, treatment-induced neuroinflammation, and neurovascular remodelling in NCC, and highlight candidate pathways and genes for future mechanistic investigation. Author SummaryNeurocysticercosis is a major cause of epilepsy in regions where Taenia solium is endemic. Brain cysts can remain viable for long periods with limited symptoms, but parasite degeneration, whether spontaneous or drug-induced, can trigger damaging neuroinflammation. In this study, we used RNA sequencing in a pig model that closely resembles human disease to characterise how brain tissue responds to viable cysts and to early treatment-induced cyst disruption. We found that viable infection was associated with local immune activation alongside reduced expression of genes involved in blood-brain barrier function. Following antiparasitic treatment, disrupted lesions showed an increased expression of genes linked to vascular and barrier remodelling. These findings suggest that the host transcriptional environment changes substantially after parasite disruption, and highlight molecular pathways that may contribute to neuroinflammation, blood-brain barrier changes, and neurological disease in NCC. As an exploratory first transcriptomic survey in this model, these results provide a candidate framework for future studies aimed at identifying biomarkers and adjunctive therapeutic targets in NCC.